中国老人医疗保障与医疗服务需求的实证分析

Medical Insurance and Medical Care Demand for the Elderly in China

本文采用2005年中国老年健康长寿调查数据库(CLHLS)22省调查数据,建立了中国65岁以上老年人群的医疗服务需求模型,实证分析了医疗保障对老人医疗服务需求的影响。本文的主要结果如下:第一,医保制度对老人医疗服务的影响主要表现在提高就医程度,而非就医选择行为的改变,同时医保制度又明显地促进了老人及时就医率。第二,医保制度对减轻老人家庭医疗负担具有显著作用。第三,城镇医保和公费医疗所发挥的作用明显高于其他保险形式。本文的基本判断是,国家医保政策在改善中国老人医疗服务利用和减轻老人家庭医疗负担方面确实发挥了良好的积极作用,并且更多惠及了就医必要性更大的老年人群,从资源配置角度看是提高效率的。因此,进一步推进全民基本医疗保障制度的建设不仅是国家惠及全民的医改重任,也是中国医疗卫生应对老龄化挑战的有效选择。

Using the 2005 Chinese Longitudinal Health Longevity Survey （CLHLS） data, this study estimates a set of medical care demand functions for the elderly aged 65 and above. The major findings are as follows. First, the medical insurance coverage primarily increases the intensity of medical care use when seeking care, rather than the choice of seeking care in general. In the meantime, the insurance coverage improves access to care for those who do need care. Second, the insurance coverage also helps reduce the financial burden of illness both in terms of changes in family-paid expenditures and relative ratios to total expenditures, in a range of 25% and 50% respectively. Third, both urban medical insurance and the government insurance have greater impact than other insurance policies as expected. Our basic conclusion is that the national medical insurance policy does increase access to care in general, with greater benefit effect on demand for necessary care, indicating an efficiency improvement in allocation of resources. Therefore, further developing the universal medical insurance policy is not only a core task of the state health reform, but also a right effective approach for China to meet the increasing challenges of aging population.